Maternal obesity, weight gain, and the black-white disparity in pregnancy outcome

描述(申请人提供)：在美国，黑人婴儿死亡的可能性是白人婴儿的2.4倍，而且更有可能经历导致发病率和死亡率的不良分娩结局。黑人女性也比白人更有可能在怀孕时肥胖，并在医学研究所(IOM)推荐的妊娠增重范围之外增加体重。孕前肥胖极大地增加了不良出生结局的风险，但这些影响可能会通过适当的体重增加而减轻。不幸的是，由于缺乏研究数据，2009年重新评估妊娠体重增加指南的医学研究所委员会无法回答一些关于最佳妊娠体重增加的最重要问题。我们的项目旨在解决他的迫切需求。我们建议检验以下假设，即最佳妊娠体重增加随着孕前BMI的增加而下降，并且BMI和体重增加是导致婴儿死亡率和不利出生结果的黑白差异的因素。我们的研究设计将使用宾夕法尼亚州现有的生命记录(2003-2008)，反映黑人和白人母亲的751,000名新生儿。该项目旨在分别为每一BMI类别的黑人和白人女性探索与最佳结果相关的总体重增加范围，并平衡这一人群中低体重和高体重增加的风险。该项目还将确定孕前体重指数和孕期体重增加对不良妊娠和婴儿结局(早产；小于胎龄儿出生；小于胎龄儿出生；非计划剖腹产；婴儿死亡率)的黑白差异的影响。这些目标的成功实现将回答一个重要的问题：产妇孕前体重和孕期体重增加--这两个潜在的可改变因素--如何促成婴儿死亡率和不良生育结果方面的种族差异？我们对生命记录数据的使用利用了一种未开发的资源来探索一个对公共卫生具有重大意义的研究问题。重要的是，这项研究还试图为关于严重肥胖女性理想妊娠体重增加的有争议的辩论提供信息。它将明确检查怀孕期间不增加或减轻体重对婴儿的安全性。 与公共卫生相关：这个项目意义重大，因为美国婴儿死亡率的种族差异和肥胖症的流行是当今公共卫生中最基本的问题之一。这项研究可能引发最终减少这种健康差距的验证性研究和干预措施的开发。为了处理2009年医学研究所委员会提出的重新评估妊娠体重增加指南的一些最紧迫的研究建议，该项目力求为所有妇女和种族/族裔群体制定基于证据的妊娠体重增加指南提供信息。

DESCRIPTION (provided by applicant): In the U.S., black infants are 2.4 times as likely to die as white infants, and are more likely to experience adverse birth outcomes that contribute to morbidity and mortality. Black women are also more likely than whites to be obese at conception and to gain outside the Institute of Medicine (IOM) recommended gestational weight gain ranges. Pregravid obesity dramatically increases risk of poor birth outcomes, but these effects may be lessened by appropriate weight gain. Unfortunately, the 2009 Institute of Medicine Committee to Reevaluate Pregnancy Weight Gain Guidelines was unable to answer some of the most important questions about optimal gestational weight gain because of a lack of research data. Our project seeks to address his urgent need. We propose to test the hypotheses that optimal gestational weight gain declines as prepregnancy BMI increases, and that BMI and weight gain are contributors to the black-white disparity in infant mortality and adverse birth outcomes. Our study design will employ existing Pennsylvania vital records (2003-2008) reflecting 751,000 births to black and white mothers. This project seeks to explore separately for black and white women in each BMI category the range of total weight gain that is associated with optimal outcomes and balances risks of low and high weight gain in this population. The project also will determine the contribution of prepregnancy BMI and pregnancy weight gain to the black-white disparity in adverse pregnancy and infant outcomes (preterm birth; small-for-gestational age birth; large-for-gestational age birth; unplanned Cesarean delivery; and infant mortality). The successful completion of these Aims will answer an important question: How do maternal pregravid weight and weight gain during pregnancy-two potentially modifiable factors-contribute to the racial disparity observed in infant mortality rates and adverse birth outcomes? Our use of vital records data leverages an untapped resource to explore a research question of major public health importance. Importantly, this study also seeks to inform the contentious debate regarding ideal gestational weight gain in severely obese women. It will explicitly examine the safety of no weight gain or weight loss during pregnancy for the infant. PUBLIC HEALTH RELEVANCE: This project is significant because the racial disparity in infant mortality and the epidemic of obesity in the U.S. are among the most fundamental problems in public health today. This research could spark confirmatory research and development of interventions that ultimately reduce such health disparities. In addressing some of the most urgent research recommendations from the 2009 Institute of Medicine Committee to Reevaluate Pregnancy Weight Gain Guidelines, this project seeks to inform the development of evidence-based gestational weight gain guidelines for all women and within racial/ethnic groups.